1) Can I use your services for all of my maternity care?

Yes! We provide full-scope maternity care for healthy women, which means that we care for all women for any preconception and pregnancy related care within the scope of midwifery. We believe in holistic management. We use complementary and alternative techniques, nutrition, and other natural healthcare treatments. We educate our clients, empowering women to care for their own bodies. West Texas Birth Services accepts all major insurances for maternity care. Our visits are typically 30–45 minutes long.



2) I am thinking of getting pregnant soon. Is there anything special I should do now?

You should get yourself as healthy as possible, mentally and physically, before a pregnancy. Stop drinking alcohol and smoking tobacco. If you take any medications, check with your health care provider to make sure they are safe during pregnancy. Stay away from toxic chemicals. Eat a healthy diet with plenty of calcium, protein, whole grains, fresh fruits, and green vegetables. Folic acid is important to help the baby’s spine and brain develop correctly, so be sure to take a vitamin with 800 mcg of folic acid during the three months before conception. Start following the Brewer Diet. This is also a good time to start a gentle exercise program like stretching, walking, or swimming. You should also see your health care provider for a ‘preconception counseling’ visit to discuss your specific concerns.



3) When should I begin prenatal care?

If you are newly pregnant, congratulations!!! You should schedule your first prenatal visit no later than the 6th-10th week of pregnancy. That is about two to six weeks after your first missed period. Optimally you should begin your care immediately for planned pregnancies, even before you conceive. Remember, we provide preconception counseling and free pregnancy testing!



4) I am pregnant and started prenatal care with another practitioner. Can I still choose your midwife services?

Absolutely! We would love to have you as a client. We typically accept transfer of care until about 36–37 weeks of pregnancy. You will fill out a ‘records request’ form that allows your previous provider to send us your medical records. Call our office at (432) 563-3297 to schedule an appointment.



5) Why should I go to a midwife?

Midwives provide better care!  For example, Midwives know that a normal pregnancy in a healthy woman is a reliable indicator of a birth that will be normal and healthy– "a normal physiological event". A CPM midwife would not consent to deliver your baby outside of a hospital unless she was satisfied that you are healthy and that your pregnancy was progressing normally. If your pregnancy exhibited any of the risk factors midwives screen for, you would give birth in a hospital. However, even the presence of some common risk factors (such as a previous large baby, previous preterm or low-birthweight baby, herpes, previous c-section, etc.) women are not automatically excluded from homebirth care. Midwives usually consider risk case by case, taking into account the history and entire health of a woman rather than simply relying on risk labels. Only a relative few high risk factors lead to appropriate and selective transfer from home to hospital.

It is important to remember that childbirth is inherently safe when the laboring and birthing processes are left undisturbed to progress naturally under the skilled attendance of a CPM. Statistically, both of the following are true:

1) If your pregnancy proceeds without complication, the chance that you or your baby would encounter a difficulty during birth that required hospital care is extremely low; and

2) The likelihood that the hospital setting and routine hospital procedures and interventions might result in a C-section is relatively high.

Additionally, consider the following advantages:

• Our Midwives focus on the entire family.
  
  
• Your visits are typically 30–45 minutes long.
  
  
• We spend time getting to know you and educate you about your body and pregnancy, providing holistic care.
  
  
• We view you and treat you as an equal partner in your care.
  
  
• We trust in the power of your body to give birth help instill this confidence in you. Instead of treating pregnancy as a ‘disease’ we work on creating healthy women, healthy pregnancies, and healthy babies.
  
  
• We are fully trained to handle complications and emergencies, should they arise.

CPM’s attend up to 5–10 percent of the births in Texas. Data supports the quality care CPM’s provide. According to public information statistics from the Texas Department of State Health Services comparing outcomes for births over a ten year period attended by CPM’s and by physicians, births attended by CPM’s had from 300–600 percent fewer infant deaths.

Furthermore, a recent large landmark study shows that CPM midwife attended homebirths are as safe (if not more safe) as physician attended hospital births. For more information on this study, see the NARM 2000 Study.



6) How is a Homebirth different from a hospital birth?

There is something about just walking into a hospital that changes the dynamics of labor. The length of labor is significantly increased in the hospital. If you put any woman in the hospital, her labor will slow down or stop because her hormonal balance changes. Her energies have to go into dealing with her strange surroundings, not into the birth itself.

When the mother has been in labor for a "reasonable" amount of time at the hospital without delivering, the doctors believe they must now "actively manage" the labor. They do not realize that the hospital setting is the cause of this problem. They will not believe that this wouldn't have happened at home.

Many "routine interventions" such as drugs, intravenous fluids, electronic monitoring and forceps occur during the hours of labor that wouldn't have existed at home. Hospitals that allow you to labor naturally for the first 10 hours won't allow you to labor naturally for the next 10 hours. At home these next 10 are spent getting to know the already delivered baby, not trying to push the baby out. In other words, the hospital environment creates many of the problems of labor and then obstetricians have to try to solve them. Homebirths occur before the miserable second half of hospital labor has a chance to start. Homebirths occur before problems happen. If women knew that most of them could have half as much labor and no complications, they would all be choosing Homebirth!



7) How are your midwife services different than a hospital midwife?

First, it must be noted that there are two types of midwife services. 1) A hospital based nurse–midwife service (CNM usually under physician supervision and in a hospital setting), and 2) an autonomous independent midwife not affiliated with a physician or hospital (Certified Professional Midwife or Licensed Midwife). Hospitals have been observing the rapid growing consumer demand for natural childbirth, and have attempted to duplicate the home environment by decorating the medical delivery rooms, and to tap in to the consumer demand for non–interventive homelike maternity care. However, it certainly takes more than interior decorating to satisfy these families. In a hospital, no matter how homelike the environment, medical obstetrics are still being practiced. As a rule, if you choose an in–hospital birth, whether from a nurse–midwife or an ob/gyn, you will receive the usual hospital care based on the medical approach for obstetrics allopathically, pathologically, and surgically, as you would with any disease, illness, injury, or medical emergency.

Conversely, a CPM Midwife practices the Midwife Model of Care in any setting, and is physically and administratively separate from any hospital or other healthcare facilities. Of course, hospitals are essential places for addressing human physiological problems and damage. But this fact does not make the hospital environment ideal, preferable, or even adequate for a childbirth in which no physiological problems or damage are anticipated. Unlike the restrictive rules of a hospital and nursing staff, a CPM midwife homebirth service, kept separate from a hospital, allows a mother to enjoy total privacy and control over her surroundings, while encouraging a sense of comfort, safety and love.

Certified Profession Midwives are guided by principles of prevention, sensitivity, safety, appropriate medical intervention, and cost effectiveness. These midwives provide family–centered care for healthy women before, during and after normal pregnancy, labor and birth. It should be noted that all CPM’s are midwives who are specifically trained to always follow the Midwives Model of Care.

Although a few nurse-midwives may attend homebirths (less than 3 percent), they receive no training from their schools in out-of-hospital settings and are typically not prepared to practice without physician supervision, unless they seek out supplemental re–training and re–education. In fact, most nurse–midwives (CNMs) stick close the medical model of care which follows a medical philosophy much like hospitals, no doubt because of their training as nurses in a medical establishment. Very few nurse–midwives practice in out–of–hospital settings due to limitations resulting from required practice agreements and malpractice insurance issues, in addition to the fact that the training of nurse–midwives does not specifically prepare them to practice in out–of–hospital settings, thus they are often called ‘medical midwives.’ Women who want to birth at home often lack access to nurse–midwives in these settings, because most nurse-midwives are uncomfortable and unprepared for a non-institutional birth setting.

In contrast, CPMs are specifically trained to practice in out–of–hospital settings. All Direct Entry Midwives or Licensed Midwives who are also NARM Certified Professional Midwives (CPMs) follow the Midwife Model of Care. The philosophy of care makes all the difference in the type and quality of care you will receive. Having state licensing statutes for CPMs makes them not only legal, but also accountable and available to all women who want to give birth with their help.



8) How safe is Homebirth?

Childbirth in itself is inherently safe when the laboring and birthing processes are left undisturbed to progress naturally under the skilled supervision of a CPM. An undisturbed birth can most appropriately occur in a homebirth setting with a Midwife in attendance practicing the Midwife Model of Care. We have overwhelming evidence of the safety of Homebirth at our fingertips.

For example, consider the largest prospective study of planned home birth with a CPM (direct–entry) midwife. This landmark study shows that CPM midwife attended homebirths are as safe as physician attended hospital births for low–risk women, yet carries a much lower rate of medical interventions, including Cesarean section. It is published online and titled: Outcomes of planned home births with certified professional midwives: large prospective study in North America. This means that planning a home birth attended by a Certified Professional Midwife offers an outcome every bit as safe (and in some cases more so) for low–risk mothers and babies as a hospital. This study is the largest yet of its kind.

In this study, Canadian researchers Johnson and Daviss used prospective data to study more than 5,400 low-risk pregnant women planning to birth at home in the United States and Canada in 2000. The researchers analyzed outcomes and medical interventions for planned home births, including transports to hospital care, and compared these results to the outcomes of 3,360,868 low–risk hospital births. According to the British Medical Journal press release, they found:

• Eighty–eight percent of the women birthed at home, with 12 percent transferring to hospital.


• Planned home birth carried a rate of 1.7 infant deaths per 1,000 births, a rate "consistent with most North American studies of intended births out of hospital and low–risk hospital births."


• There were no maternal deaths.


• Medical intervention rates of planned home births were dramatically lower than of planned hospital births, including: episiotomy rate of 2.1 percent (33.0 percent in hospital), Cesarean section rate of 3.7 percent (19.0 percent in hospital), forceps rate of 1.0 percent (2.2 percent in hospital), induction rate of 9.6 percent (21 percent in hospital), and electronic fetal monitoring rate of 9.6 percent (84.3 percent in hospital).


• Ninety–seven percent of the more than 500 participants who were randomly contacted to validate birth outcomes reported that they were extremely or very satisfied with the care they received.

Read this interesting comment in response to this study by Marsden Wagner, MD, titled Silence of the Lions.

An important study recently published on homebirth is in the CMAJ. It reveals homebirth to be safer than hospital birth for low risk women, even in cases of vaginal birth after caesarian (VBAC)! It is published online and titled: Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician.

More evidence is a two-year study conducted by the U.S. Centers for Disease Control indicates that a planned home birth with an experienced attendant is safer than a hospital birth. The results of the study showed that the infant death rate in hospitals was 12 per 1,000 live births; whereas the death rate for planned, attended home births was 4 per 1,000 live births. *Center for Disease Control, "Live births by place of delivery and race of mother, 1992", section 1, Natality, page 246

Additionally, In 1990, the World Health Organization stated that using midwife care during pregnancy and childbirth led to more favorable outcomes for mothers and babies and urged all countries to offer midwifery education, confident that the increased availability of midwives would improve birth outcomes throughout the world.

This is a large study of midwife-attended births in home and hospital of 529,688 births, of which 60.7% (over 321,500) were planned home births titled: Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Bennebroek Gravenhorst J, Buitendijk S. BJOG 2009.

One important measure of the safety of birth place is infant mortality, specifically, neonatal deaths within the first 28 days. These Texas statistics of M.D. Attended Birth vs. Midwife Attended Birth is from the Texas Department of State Health Services, Bureau of Vital Statistics. It compares the infant mortality (death) rate as follows:

Medical Doctor infant Mortality (death) Rate vs. Midwife infant Mortality Rate
Per 1000 Births
Year            MD infant deaths       Midwife infant deaths
1990                       7.6                              3.0
1991                       7.3                              3.0
1992                       7.5                              2.3
1993                       7.3                              1.8
1994                       6.8                              1.7
1995                       6.5                              2.1
1996                       6.3                              1.1
1997                       6.1                              2.8
1998                       5.7                              1.7
1999                       6.0                              1.2
2000                       5.5                              0.3

These statistics show that midwifery in Texas has been statistically safer than hospital birth by a factor of 3 to 6. That is, midwife attended out-of-hospital births, at various times during the period of modern record keeping, have been 300% to 600% safer than physician attended hospital births in Texas.

Also, please read The Millbank Report: Evidence-Based Maternity Care which recognizes the Certified Professional Midwife (CPM) as the benchmark for low intervention and good outcomes.

All of this evidence has also been supported by the Cochrane Libraray (ISSN 1464-780X) for Midwife-led maternity care versus other models for childbearing women.



9) What is your c-section rate?

In the United states, the national average of all c-section rates is now over 33%, and some hospitals in our area have c-section rates much higher than that (note: typically only the first c-section performed on a patient called a "primary" is reported to the public, excluding all repeat c-sections, often justified by the fallacy 'once a c-section, always a c-section'). However, according to the World Health Organization, the overall c-section rate for any country should be no higher than 10% - 15%. This ideal rate is sometimes dismissed as arbitrary at best, yet even if the 'ideal rate' were closer to 20%, it would still amount to approximately 509,420 unnecessary surgical deliveries in the United States.

Throughout Texas, the state average of all births as reported to the CDC (90% of which are hospital births) currently has a 35% c-section rate. In contrast, for all midwives the national average c-section rate is less than 12% (note: just like some medical doctors, midwives do not perform the actual c-section surgeries themselves, so for the purpose of calculating a 'c-section rate' any transfer of care resulting in a c-section would be counted).

In our CPM midwife practice our transfer of care for c-section rate is exceptionally low, about 0–5%.

This brings us to the question of c-section necessity. Remember, it is not the hospital itself that decides whether a c-section is based on a true medical necessity or not, it is decided by the medical doctor employed by the hospital. Of course, we all know a c-section can be an essential life-saving surgery for both mother and child when performed based on a true medical indication. However, far too many women and their partners are unnecessarily coerced into the surgery by medical doctors under the argument that it's what's best for their baby or babies and for their body.

So the statistical rates for c-sections alone say nothing about the true medical necessity of the surgery, they only tell us how many statistically are performed. Nevertheless, these rates do give us one of the many 'tools of measurement' for the sake of comparison of childbirth outcomes for both maternity care practitioner types, and for birth locations (note: for more information on hospital based maternity care, see our section on The Medical Doctor and Modern Obstetrics).



10) What is the difference between a Homebirth and a birthing center?

There is no difference between a CPM Midwife attended birth at Home (Homebirth) and a CPM Midwife attended birth at a birthing center, as far as the equipment that is brought to your birth and the actual services of the midwife, provided the midwife follows the Midwife Model of Care at the highest possible industry standards.

Nevertheless, Homebirth with WTBS has many advantages that a birthing center cannot match. Consider the following examples:

• Many Homebirthing women express that it's more than just the physical comfort of your own home that you anticipate; it is also the psychological comfort of being at home as well as not commuting during labor. It is about being comfortable and feeling secure and relaxed, which in turn contributes to a labor that progresses steadily and naturally. For many women, the most important difference between delivering in a birth center (whether detached from a hospital or not) and at home is the commute to and from the center, at a time you would least feel like getting into a car and driving someplace.
  
  
• Health care facilities care for multiple patients and are therefore constantly battling infectious germs and antibiotic resistant strains of bacteria. However, you are already immune to the germs in your own home and there are no other pregnant women being cared for in your home. Therefore, you are not exposed to the potential contraction of infectious microbes and blood borne pathogens that are common to both non-hospital birthing centers and in hospital birthing centers.
  
  
• Birthing center midwives also have larger financial overhead due to facility costs and the increased regulatory pressure to prevent the strict non-compliance violations. Birthing centers must meet the high financial demands of their industry, typically by reducing their fees and increasing the volume of women seen. But is a reduced fee in an institutional setting really worth the sacrifice of one-on-one individualized care? It is quite common for birthing centers to care for several laboring women at the same time, just as hospitals do. Often, the birthing center midwives who attempt to also provide homebirths are just too overextended to accomodate them, even when promised. For example, when caring for multiple women in a birthing center setting, a patient planning a homebirth whose due date has approached another patients due date, would be required (usually at the last minute while in labor) to give birth in the birthing center instead, solely because the birthing center midwives have chose to care for multiple patients simultainiously. Then, the patients are sent home, only to be required to return to the birthing center the next day for a postpartum visit (if postpartum care is an offered service).
  
  
• Birthing centers are likewise subject to strict regulatory limitations. For example, in Texas birthing centers are required to not allow women admitted in labor to exceed 24 hours of labor. This means that once you are admitted to the birthing center in labor you are "on the clock", just as you are in hospitals. This point is important because it is quite common for labor to last longer than 24 hours. This is especially true when the Natural Alignment Plateau is included as a normal part of active labor, as it should be, rather than mistakenly labeling it as "failure to progress" and unnecessarily transfering care to a hospital.
  This also means that typically the birth center practitioners attending you do not know how, or are not allowed, to work with your body naturally. When the time begins to approach the cut off point, they may simply resort to a medical type management of your labor, or transfer you to a hospital, solely to remain in compliance with their mandated rules and regulations.
  Therefore, the state mandated time a woman can labor in a birthing center means that if the required progress is not observed within the regulated time frame, legal and regulatory pressure will be put on the birthing center owner (even if this is a CPM or CNM) and you will no doubt be subject to unnecessary medical interventions (which is typically the main cause of new complications requiring more medical intervention), transfer to a hospital, and much too often an otherwise avoidable cesarean section.
  Of course the purpose of regulating health care facilities and practitioners is intended to protect the public. However, the regulations that govern birthing centers are typically created and enforced by government agencies and lawmakers who view the medical model of obstetrics as the optimal standard of care. This is also why you see mostly medical midwives and nurse-midwives working in birthing centers. These midwives typically stray from the Midwife Model of Care and rely on routine high risk type interventions similar to that of obstetricians.
  Fortunately, CPM Midwife Attended Homebirths have no such time constraint.
  
  
• Although some women view a birthing center as simpler for purposes of space and cleanup, in reality this makes very little difference for most homebirthers. For example, most birthing center rooms are smaller than an average bedroom in a home. Additionally, most homebirth midwives take care of the clean up tasks themselves at each homebirth. When we compare the added stress of an institutional facility environment at a birthing center, this trade off has very little advantage if any, except possibly for the case when a woman for whatever reason does not have a home to use for her birth, or if no homebirth midwife is available. In that case a birthing center would most likely be better than a hospital setting, but again only in the case when the option of a homebirth midwife (who does not also work in a birthing center) is unavailable.
  Nevertheless, the most common reason a homebirth midwife would choose to operate a birthing center is to care for multiple women simultaneously, with the objective of increasing financial profit. This objective is not necessarily harmful in itself, unless of course it affects the quality of care in a negative way, which is more often than not due to the overlapping of due dates. Even in the case where two midwives operate a birthing center together, they will generally only work together as one team. In this case they may promise women that they will receive two midwives for the price of one, but ironically in a birth center setting, this arrangement may very well result in a reduced quality of care. For example, if multiple women are cared for at a birthing center and when due dates overlap, the midwives must juggle their time caring for each woman, simultaneously. This could easily overextend the midwives, just as we see with most physicians and nurses in a hospital setting. If this occurs, it increases the risk of reducing the quality of care provided.
  However, A midwife attended birth at home eliminates this scenario, assuming the midwife does not accept multiple clients with the same due date, and the midwife does not operate a birthing center.
  
  
• Most birthing centers will not allow a VBAC (Vaginal Birth After Cesarean) due to the political environment of the regulatory bodies over birthing centers, even though VBAC's are a variation of normal. However, a CPM Midwife Attended Homebirth will allow appropriate VBAC's (frequently called HBAC - Homebirth After Cesarean).
  
  
• Institutional birthing does not usually allow for follow up home care. For example, the childbearing cycle does not just pause itself for six weeks following birth and then end after a quick six-week check-up in an institution. Even if birth is easy, childbirth may still be traumatic stressor in that it is a major life change. Positive changes in life cause stress, too. Coupled with loss of sleep, change in lifestyle and physical recovery, the need for support after birth is not something that can be downplayed. Institutions, including birth centers, are not typically set up to provide as much continuous one-on-one care as homebirth midwives (who do not operate a birthing center) can provide.
  
  
• A simple risk/benefit analysis of a Midwife Attended Homebirth verses a birthing center will reveal interesting results. For example, when compared to a Homebirth, being in a birthing center does not improve safety, health, outcome, or the birth experience. Combine this with the increased risk of unnecessary interventions due to mandated time constraints and other medical type regulations, the typical refusal of VBAC's, the lack of physical/psychological comfort, and the burden of commuting while in labor, it is easy to conclude that there is really no incentive to choose a birthing center, other than the illusion of more technology and/or the false perception of increased safety because of being in an institutional setting.
  
  
• Homebirth allows the full spectrum of natural birthing scenarios uninhibited by the practice of medicine, or the stress of an unfamilar facility. The familiar home territory and freedom allows a ‘safe and secure’ response which releases endorphins creating a sense of well being and providing natural pain relief. Just the opposite is true of the unfamiliar territory of a birthing center (or a restrictive hospital setting), which triggers the ‘fight or flight’ response that releases excess adrenaline potentially stalling labor and creating tension and pain (see also our Homecourt Advantage page).


11) I’ve heard that midwives only care for ‘low risk’ pregnancies. What is ‘high risk’?

We believe that pregnancy and childbirth are physiological normal and natural events and that your body knows how to give birth. Your age and number of prior pregnancies do not matter to us, as long as you are reasonably healthy. We provide all of your prenatal and postpartum care, whether you begin with us or transfer from another provider. We can deliver babies after 36 weeks gestation (4 weeks before your due date) and up to 42 weeks gestation (two weeks past your due date), and even longer with proper assessment. Nevertheless, there are rare high-risk situations that are potentially not appropriate for out-of-hospital birth without specailist consultion and/or co-care. The rare high-risk situations that are typically not suitable for a homebirth, without consultation with a specialist, include: chronic high blood pressure, diabetes requiring insulin, placenta previa (the placenta is over the cervix), pregnancy induced hypertension/ preeclampisa (aka toxemia), or a medical problem with the baby (heart defect, etc) that will require special care, among some other health problems that your midwife can identify. Keep in mind that these are very rare conditions, even if you have be diagnosed in prior pregnancies. If you have a question about your ‘risk status’, please call our midwife services line at (432) 563-3297.



12) If I choose your midwife services for my prenatal care, can I still get an ultrasound?

Of course. Midwives are not anti-technology; we believe in the appropriate use of technology and informed choice/consent. Your pregnancy and birth are yours– we are here to educate you and make it as positive an experience as possible. You can opt for as many or few interventions (ultrasounds, labs, etc.) as you like, as long as you understand the risks and benefits of accepting or declining.



13) How much does West Texas Birth Services cost for prenatal care and delivery?

We have a reasonable fee that covers all of your prenatal care, labor and birth, postpartum care, home visits, classes, and newborn care. Midwife service costs are typically less than the cost of a birth in a hospital depending on your geographical region. We provide interest free financing for all of our clients. We also have optional extended interest free financing plans for those who want lower monthly payments that extend beyond your due date. Please contact our office for details on these plans.



14) Do you take insurance?

Yes. We accept all major insurances. Please call our office to verify your coverage eligibility. All insurance clients are also eligible for our normal financing and extended financing, if needed.



15) What is Natural Childbirth?

Natural Childbirth is a method of using deep relaxation, slow breathing patterns and self-guided release of endorphins (the body's natural opiates), to help the birthing mother enjoy an un-medicated, safe and gentle birth, often more quickly and without pain. Natural Childbirth Classes are offered at West Texas Birth Services for all clients. Any non-clients who desire a natural childbirth class, please call our office for availability.

An important part of natural childbirth is the Midwife Model of care, which includes avoiding unnecessary interventions, avoiding routine drugs, and choosing a planned birth location that allows for undisturbed labor in a physically and psychologically safe environment. There are wonderful advantages to natural childbirth.

This knowledge in no way diminishes the value of appropriate medical intervention when a true medical complication developes. But remember, true complications are extremely rare, and most are either iatrogenic or nonsocomial. Armed with the true safe nature of childbirth, families are able to avoid unnessasary interventions, with all of the benifits nature has to offer. All this requires is the desire to learn, and guidance from your midwife to inform yourself. Women who have experienced a routine medicalized birth, often express extreme disatisfaction and sometimes presumably conclude that without all the drugs and intervention, it would been even worse. However, this is a fallacy. For example, Davis-Floyd points out that most women, by having routine medicalized interventions that keep them from a healthier birth experience, don't even realize what they've missed: "They don't understand the [true] value of natural hormones and how epidurals completely cut off the flow of natural oxytocin. Some of the price for that comes out later, in terms of bonding and success of breastfeeding. Those are subtle things [they] may not connect together." In fact, evidence presented by physicians as Dr. Sarah Buckley tells us that it is possible to experience a state of ecstasy in births during which women are not exposed to fearful scenarios. In such situations, the cocktail of hormones naturally produced by a mother during birth is allowed to perform its magic.

Scientists have long observed that this amnesiac condition occurs naturally in birth for all mammals as the laboring mother nears the end of the opening phase of her labor. This transitional period, typically dreaded by medical practitioners (and the most frequent time drugs are offered), refered to by other methods as "transition," naturally dissappears as the laboring mother slips into a tranquil state, and goes deeper within, to her baby and her birthing body, leaving all the distractions of the rest of the world behind as she and her baby connect and give birth.



16) Are there any books I should get to prepare for pregnancy and birth?

Every individual has their favorite books, because each book affects the reader in a unique way. Look for authors who support normalcy, the power of your body, and holistic management of pregnancy/ birth. We have a large lending library of many of our favorite books for our clients. Some of our top picks are listed on our Sites and Books section of this website, or our WTBS Store.



17) Who can be at my birth?

There are no restrictions on how many people you can have at your birth. You can bring as many friends and family members as you like (provided they will all fit in the birthing home location), or you can come alone with your partner/ labor support. There is always a midwife present for deliveries. The midwife is with you for your entire labor and birth.



18) Can I eat and drink during labor?

Of course! Your body is working hard and needs energy. You would never run a marathon without fluids, would you? You need to stay hydrated and drink plenty of fluids, especially water and sometimes those with nutrients and calories (like juice, sports drinks, and some herbal teas) to keep your muscles working as effectively as possible. Many women lose their appetite during labor, but you are encouraged to eat light foods if you feel like it. Follow your body.



19) How will I cope with labor?

Some women will tell you that they ‘couldn’t have done it without an epidural’. Well, take a look at the big picture. When you strap a woman to the bed (usually on her back) with electronic monitors and IVs, leave her alone in a sterile hospital room, take away her clothes, forbid her to eat or drink, take all power and control away, and stress her out with a constant stream of strangers in the room (many performing exams and "managing" labor), what other coping mechanisms does she have? When drugs such as Pitocin are used to induce or augment labor, the pain of labor typically becomes much worse than normal, leading the obstetrician to administer more drugs such as Stadol and an epidural (which ironically slows or stalls labor, leading to the administering of more Pitocin), with the risks and side effects increasing in complexity with each drug administered. For an excellent overall view of the data on risks of pharmacological induction of labor, including studies showing that uterine stimulant drugs increase labor pain, as well as the risks of an epidural, such as a sudden fall in blood pressure– depriving the baby of oxygen, and the risk of permanent paralysis or death resulting from the anesthesia, see H. Goer, The Thinking Woman’s Guide to a Better Birth, which you can find here, and D. Korte, A Good Birth, A Safe Birth : Choosing and Having the Childbirth Experience You Want, which you can find here.

We must note here that because obstetricians are surgeons, they turn normal low-risk birth into a surgical procedure. Proof of this is that the healthy birthing woman in a hospital setting is treated as if she is a surgical patient: she is put on her back in a bed that is really a modified surgical table, often with her legs up in surgical stirrups. For more than 25 years we have known scientifically that this is the worst of all possible positions (and most painful) for a woman giving birth; in this position the baby's head compresses the woman's main blood vessel that supplies the womb and the baby and reduces the blood and oxygen going to the baby, leading to a host of problems including Shoulder Dystocia and Obstetrical Brachial Plexus Injury. However, if the woman is in a vertical position (sitting, squatting, side-lying, or standing), more blood and oxygen flow to the baby, the woman's bony pelvis opens more to let the baby out and she gives birth downhill instead of uphill against gravity. In addition, the use of epidurals has been implicated to cause an increase in the incidence of cesarean sections for shoulder dystocias (10% vs. 3.8 % without epidurals). Furthermore, Stoddart et al., in a well-controlled randomized prospective study, showed that epidural anesthesia affects rotation of the shoulders because it relaxes the pelvic floor. This means the relaxation of the woman's pelvic muscles that epidurals bring, may prevent those muscles from assisting in the usual rotation of the fetus as it moves to a normal birth position. Being in a recumbent position (lying down) has also been implicated in slowing down the baby's descent, prolonging the labor process, and potentially closing the birthing canal by up to 30%. Nevertheless, despite all of this evidence, the far majority of hospitals and obstetricians are ignoring all scientific data and still pretending that normal birth is a surgical procedure. Any womans' right to chose a superior natural childbirth option will not be supported in a hospital setting. So goes the medical model of obstetrics.

We take a very different approach at West Texas Birth Services. For example, research shows that stress hormones increase pain and slow the progress of labor. By implementing the Midwife Model of Care with minimal intervention (if any at all), we make your labor as low-stress as possible. We do not perform unnecessary interventions or keep you on a ‘labor curve’, which allows you to essentially difine the 'role' of your midwife. You are familiar with your midwife and home birth environment, wear your own clothes, and eat your own food. During labor you are encouraged to walk and change positions often. We encourage rocking chairs, birth balls, and soft beds to help you get into the most comfortable position. We encourage the use heat and massage on sore backs. Hydrotherapy (warm water immersion tubs) have been shown to decrease the pain of labor, so we encourage women to labor in our midwife provided birthing pools, and if desired, enjoy an under water birth (see also our Waterbirth section). You are surrounded by continuous support from the midwife and your labor support team and partner.

When you are allowed to follow your body undisturbed, labor is very manageable without the need for pharmaceutical drugs or medical intervention. Women instinctively get into the best position for their labor and birth, usually side-lying, standing, or hands and knees (all of which can be in our warm water birthing pools).



20) Do you cut episiotomies?

No, we do not perform routine episiotomies (a surgical cut to enlarge the vaginal opening). Surprisingly, despite the fact that they are shown to do more harm than good, episiotomies are one of the most common surgeries for women in the United States, and are frequently done without the womans' consent during delivery. Instead of episiotomies, we use warm perineal compresses and oils during birth to ease the passage of the babies head, thereby minimizing tears. Although we are fully trained to perform episiotomies and to repair cuts or lacerations/tears, episiotomies are essentially never medically necessary, and are often the primary cause of tears (the tear starts where the cut is made). For more details, select this link for information on Episiotomy: The Ritual Genital Mutilation in Western Obstetrics. There are numerous scientific studies on the risks of episiotomy. For example, one of the proven risks is long-term painful sexual intercourse (a review found that women with episiotomies were 53 percent more likely to suffer pain during intercourse three months after giving birth, K. Hartman et al., "Outcomes of Routine Episiotomy: A Systematic Review, Journal of the American medical Association 293 (2005):2141-48; and for an argument that routine episiotomy is the Western form of female genital mutilation, see M. Wagner, Episiotomy: A Form of Genital Mutilation, Lancet 353 (199): 1977-78), (see also our Waterbirth section).



21) How do you monitor the baby during labor?

We use a handheld Doppler to listen to the baby's heartbeat during labor. This is called intermittent auscultation. Research shows that listening intermittently is equally as effective as continuous electronic fetal monitoring (EFM) in identifying problems during labor and delivery. In fact, studies show that intermittent auscultation results in lower rates of c-sections with the same neonatal outcomes. And of course, we also use stethoscopes and fetoscopes as needed.



22) What happens if there is a problem during my pregnancy?

To answer this, it's important to understand what a Midwife does. Midwives specialize in normal pregnancy, labor, and birth. We focus on creating healthy women and families to prevent complications. Midwives are well trained to handle low to moderate problems safely, without transfering your care. In rare cases, if problems arise that are outside of the scope of care that a midwife provides, Licensed CPM Midwives, as with any autonomous healthcare practitioner, will consult with other specialists for any condition outside their own specialty. Remember, the practice of midwifery is very different from the practice of nursing. CPM Midwives are not assistants to physicians. They are autonomous professionals who provide primary maternity care and are analogous to family physicians who provide primary health care.

For example, if a family physician hears a heart murmur in a patient, the patient will be referred to a specialist cardiologist. This certainly does not mean that the family physician is the cardiologist's "assistant" or somehow less competent, but only that the cardiologist has a specific expertise for certain medical abnormalities, which are different than those of the family physician. The cardiologist then makes suggestions for treatment of the family physician's patient, which the family physician and patient may, or may not, choose to follow. The cardiologist and the family physician are professional equals who collaborate with mutual respect to provide the best quality care for the patient. By the same token, a high-risk pregnancy specialist, such as an obstetrician, does not give orders to a midwife any more than a cardiologist gives orders to a family physician. The midwife may refer a woman to a high-risk obstetrician because of a medical complication, but the midwife and obstetrician then collaborate as professional equals.

With this in mind, if an abnormal condition requiring medical assistance arises during your pregnancy that is outside the realm of your midwife's specialty, the midwife consults with a collaborating specialist for whatever high-risk symptom you have, or you are scheduled for a visit with that specialist. Of course, in the rare event that a condition results in a permanent high-risk status during your pregnancy, your midwife will either transfer your care to the appropriate specialist, or provide co-care. For more on this, see our section on The Role of a Hospital and our Facts and Myths section on Who should oversee the birth?



23) What if there is a complication during my birth?

During birth, the midwife carefully monitors both the mother and baby. Keep in mind that Licensed CPM Midwives are well trained to look for and handle potential complications, and repeatedly screen all clients for risk factors. For the rare occurrence of a complication during birth requiring medical assistance, emergency equipment on hand is used to stabilize mother and baby for transfer to the hospital. However, despite the perceived harm associated with birth, true emergency complications are very rare, and majority of any potential complication is prevented or handled safely by the midwife.

Some medical organizations in the United States such as ACOG (The American Congress of Obstetricians and Gynecologists, a trade union representing the financial and professional interests of obstetricians) claim they are only against homebirth out of fear of a delay of accessibility for an emergency hospital c-section (without any evidence to support this fear). In truth however, assuming you live within fifty miles of a hospital, in the extremely rare event that a true complication developed that required a c-section, the response time for a hospital to prepare for an emergency c-section is typically longer than the travel time en route to the hospital. For example, just the average response time alone for the anesthesiologist on call to arrive at a hospital is around 45 minutes (which does not include the surgeon on call, and other preparations). If a midwife calls emergency services, the hospital should have ample time to prepare while the transport occurs. So, if there is any delay it would be on hospitals part. Proof of this is evidenced in the fact that although ACOG opposes out-of-hospital homebirths, in the same breath they support out-of-hospital births in an accredited freestanding birthing center (which are almost universally owned and operated by midwives), that would also have an emergency hospital transport time equivalent to that of a homebirth– which therefore, belies their claim of any safety issue regarding transport time.

Additionally, complications seen in low-risk women laboring in hospitals are often related to the many routine practices and interventions that disturb the birth process and cause or lead to complications and more interventions. In fact, most of these practices were adopted without being studied for safety, and many are still routine even after being studied and found to be either worthless or harmful or both (Enkin et al. A Guide to Effective Care in Pregnancy and Childbirth www.childbirthconnection.org). Midwives attending home births avoid unnecessary interventions and the use of drugs, allowing normal birth to proceed. They are trained and experienced in noticing any signs of problems and taking appropriate action, including transfer to medical care in a hospital when necessary, which is rarely. In fact, when attending births outside the hospital, Certified Professional Midwives (and non-medical homebirth CNMs) referred fewer than 5% of mothers for cesarean sections, while obstetricians were performing cesarean sections on over 33% nationally and rising (in Texas it is over 60%) of low risk mothers in hospitals (see also 2006 CfM fact sheet with references at: http://www.cfmidwifery.org/pdf/cesarean2x.pdf).

When a rare but appropriate hospital transfer does occur from the care of a midwife, the midwives in our practice will stay with the laboring or postpartum woman during her hospital visit, and will later provide postpartum and newborn care as well as continued breastfeeding support in the privacy of the woman's home.

Today’s obstetrical profession performs cesarean sections for over one third of births, induces labor in nearly half of births, and administers drugs of one kind or another to more than two thirds- and yet scientific evidence proves that all drugs pass through the placenta and harm the baby. In fact, almost the only women who give birth with no interventions are those who give birth at home. (Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences. New York: Maternity Center Association, October 2002.)

Keep in mind also that although ACOG acknowledges that childbirth is a normal physiological process, the medical approach to childbirth is still based on fear and control. Obstetricians are not trained to support normal birth, but ironically, they often oppose the very health care providers who are: midwives who are trained and experienced in attending births outside the hospital. The Certified Professional Midwife credential is the only maternity care credential that requires experience in out-of-hospital settings. The bottom line is that evidence based research proves that CPM attended homebirths are safe. And– although the United States has the second worst infant mortality (death) rate in the world, when extremely low infant mortality rates of midwives are compared to the high infant mortality rates of physicians, the statistics speak for themselves. Many women are shocked to learn that modern OB care is driven by beliefs and practices that are counter to the needs of mothers and babies, and result in birth outcomes that are some of the worst in the world, despite the fact that the United States spends more on birth care than any other country. Interestingly, all other countries with the best outcomes have one thing in common– they use midwives, with their low tech, and high touch skill system of care, for 80–90 % of all births that occur in their country (see also our Facts and Myths section).



24) If I transfer to the hospital because of an emergency, what does the midwife do?

When a rare, but appropriate, hospital transfer does occur for a true medical complication, from the care of a midwife, the midwives in our practice will stay with the laboring or postpartum woman during her hospital visit, and will later provide postpartum and newborn care as well as continued breastfeeding support in the privacy of the woman's home (see also FAQ #22 above: What if there is a complication during my birth?).



25) How long do you stay after my birth?

Unlike hospitals which typically require rooming in for several days, our clients are healthy women with normal, un-medicated births and healthy babies. We stay with you a minimum of three hours after the birth to make sure mother and baby are okay and breastfeeding has been established. Before we leave, we show you how to check ‘vital signs’ on you and the baby. The first day you check ‘vitals’ four times and call us with the results. Then your Midwife sees the baby within the first 24 hours after the birth. We check on you and the baby, taking blood for the baby’s metabolic screen, checking the baby’s weight, and helping with breastfeeding. The second postpartum is on day three–five, the third is at two–three weeks, the fourth is at five–six weeks, and lactation support visits are scheduled as needed. Of course, we are also available indefinitely for breastfeeding support, wellness consultations, annual exams, and other health concerns.